How Long Will My Employee Be Off Work? Applying Evidence-Based Injury Duration Guidelines

Efficient management of workers’ compensation claims significantly impacts both employee recovery outcomes and organizational costs. Evidence-based medicine (EBM) guidelines, particularly injury duration guidelines, provide structured estimates of typical recovery periods, helping set realistic recovery expectations and facilitating effective claims management.

What are Injury Duration Guidelines?

Injury duration guidelines, provided by sources like Official Disability Guidelines (ODG) and MDGuidelines, deliver evidence-based timelines for recovery from specific injuries. These guidelines answer the frequent question asked at the time of injury: “How long will my employee be off work?” They serve three primary purposes for employers and adjusters:

1. Reasonableness Assessment: Determine whether the reported absence duration aligns with typical recovery times.
2. Intervention Identification: Recognize when additional claims management or medical interventions are necessary.
3. Savings Benchmarking: Calculate potential financial savings achieved through effective return-to-work strategies.

Applying Duration Guidelines in Claims Management

Consider a practical example where an employee sustains a rotator cuff injury and anticipates needing six months off work. Injury duration guidelines indicate the expected recovery time for this injury is about 42 days for heavy-duty work. This significant discrepancy should prompt the claims manager to:

• Investigate the Reasoning: Understand why the employee anticipates such a prolonged absence compared to typical recovery times.
• Collaborate with Medical Providers: Verify treatment necessity and appropriateness, ensuring alignment with standard medical guidelines.
• Implement a Modified Work Program: Offer the employee suitable lighter duties, facilitating an earlier return to work and reducing lost wage indemnity payments by potentially saving four to five months of absence.

Regular monitoring against these guidelines ensures interventions remain timely and appropriate.

Common Misconceptions

It’s essential to understand injury duration guidelines as benchmarks for full recovery rather than mandatory absence durations. Over 90% of injured workers can safely resume modified duties within days of injury, well before achieving complete healing.

Recommendations for Claims Professionals

Claims professionals should effectively leverage injury duration guidelines by:

• Regularly Consulting Guidelines: Integrate these benchmarks into routine claims assessments.
• Maintaining Clear Communication: Actively engage with medical teams to ensure compliance with evidence-based treatments.
• Encouraging Modified Duties: Facilitate flexible, lighter-duty assignments promptly following an injury.

Benefits of Effective EBM Integration

Strategically applying injury duration guidelines enhances claims management by reducing unnecessary absence durations, expediting employee recovery, and optimizing organizational cost-efficiency. By leveraging evidence-based medicine effectively, employers and adjusters can manage claims confidently, control costs, and promote a healthier, more productive workforce.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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